Hilton Muniz Leão Filho

Purpose To evaluate intraobserver and interobserver agreement in the interpretation of subtle MRI findings classified as minimal endometriosis, to assess the impact of the Kappa paradox in low-prevalence compartments, and to compare blinded rereads with the original prospective reports. Materials and methods In this retrospective study, 100 pelvic MRI examinations (50 originally reported as minimal or incipient endometriosis and 50 originally reported as normal) were independently reviewed by three radiologists on two blinded occasions 4–8 weeks apart. Seven anatomical compartments were assessed. Agreement was measured with Cohen’s Kappa, Fleiss’ Kappa, PABAK, Gwet’s AC1, and positive/negative agreement. Original reports were used as a clinical reference for descriptive comparison, and exact McNemar tests assessed directional asymmetry of discordance. Results Intraobserver agreement for any finding was fair (mean Kappa = 0.36, 95%CI 0.16–0.54; AC1 = 0.49), and interobserver agreement was also fair (Fleiss Kappa = 0.28; AC1 = 0.40). Agreement was consistently stronger for negative than for positive classifications. Ovarian findings showed the highest reproducibility, whereas very low-prevalence compartments showed a marked Kappa paradox. Multicategory analysis of uterosacral ligament laterality reduced agreement, mainly because unilateral-versus-bilateral disagreement remained frequent among positive cases. Comparison with original reports showed slight-to-moderate agreement (Kappa 0.18–0.46), with specificity (76–86%) consistently exceeding sensitivity (32–66%), indicating a more restricted threshold on blinded rereads, particularly for uterosacral ligament involvement. Conclusions Agreement for subtle MRI findings interpreted as minimal endometriosis was only fair and clearly lower than that usually reported for deep endometriosis. Low-prevalence compartments were strongly affected by the Kappa paradox, and the low-to-moderate discordance with original reports, driven primarily by lower sensitivity on blinded rereads, supports the need for clearer operational criteria and more standardized interpretation.

Background: Iron (Fe) supplementation is a critical component of anemia therapy for patients with chronic kidney disease (CKD). However, serum Fe, ferritin, and transferrin saturation, used to guide Fe replacement, are far from optimal, as they can be influenced by malnutrition and inflammation. Currently, there is a trend of increasing Fe supplementation to target high ferritin levels, although the long-term risk has been overlooked. Methods: We prospectively enrolled 28 patients with CKD on hemodialysis with high serum ferritin (> 1000 ng/ml) and tested the effects of 1-year deferoxamine treatment, accompanied by withdrawal of Fe administration, on laboratory parameters (Fe status, inflammatory and CKD-MBD markers), heart, liver, and iliac crest Fe deposition (quantitative magnetic resonance imaging [MRI]), and bone biopsy (histomorphometry and counting of the number of Fe positive cells in the bone marrow). Results: MRI parameters showed that none of the patients had heart iron overload, but they all presented iron overload in the liver and bone marrow, which was confirmed by bone histology. After therapy, ferritin levels decreased, although neither hemoglobin levels nor erythropoietin dose was changed. A significant decrease in hepcidin and FGF-23 levels was observed. Fe accumulation was improved in the liver and bone marrow, reaching normal values only in the bone marrow. No significant changes in turnover, mineralization or volume were observed. Conclusions: Our data suggest that treatment with deferoxamine was safe and could improve Fe accumulation, as measured by MRI and histomorphometry. Whether MRI is considered a standard tool for investigating bone marrow Fe accumulation requires further investigation. Registry and the registration number of clinical trial: ReBEC (Registro Brasileiro de Ensaios Clinicos) under the identification RBR-3rnskcj available at: https://ensaiosclinicos.gov.br/pesquisador.

This comprehensive review explores a wide range of imaging findings associated with the gallbladder (GB), from anatomic variants to rare diseases. Through an in-depth review of diagnostic modalities including ultrasound, magnetic resonance cholangiopancreatography, CT, and MRI, we aim to highlight the crucial role of imaging techniques in diagnosing GB disorders, as congenital anomalies, inflammatory diseases, neoplasms, and surgical complications. Employing a detailed analysis and comparison of imaging findings across various modalities, this review seeks to improve diagnostic accuracy for GB-related pathologies, facilitating optimal patient management. Graphical abstract

The fatty liver disease represents a complex, multifaceted challenge, requiring a multidisciplinary approach for effective management and research. This article uses conventional and advanced imaging techniques to explore the etiology, imaging patterns, and quantification methods of hepatic steatosis. Particular emphasis is placed on the challenges and advancements in the imaging diagnostics of fatty liver disease. Techniques such as ultrasound, CT, MRI, and elastography are indispensable for providing deep insights into the liver's fat content. These modalities not only distinguish between diffuse and focal steatosis but also help identify accompanying conditions, such as inflammation and fibrosis, which are critical for accurate diagnosis and management. Graphical abstract

Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. ^©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.

Fat accumulation within the liver (hepatic steatosis) has been increasingly recognized as playing a significant role in the development of liver disease. Its prevalence was estimated to be approximately 38% worldwide in the 2016–2019 period, corresponding to a 50% increase in comparison with the 25% estimated for the 1990–2006 period(¹ 1 Younossi ZM, Golabi P, Paik JM, et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77:1335–47. ). In Latin America alone, hepatic steatosis affects approximately 24% of the population(² 2 Díaz LA, Villota-Rivas M, Barrera F, et al. The burden of liver disease in Latin America. Ann. Hepatol. 2024;29:101175. ). Hepatic fat deposition is typically associated with metabolic syndrome, cardiovascular disease, and even diabetes, as well as with an increased risk of developing atherosclerosis(³ 3 Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67:328–57. ,⁴ 4 Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84. ). These associations prompted a change in the nomenclature related to the spectrum of steatotic liver disease (SLD), with the subtype comprising fat deposition, metabolic syndrome, and alcohol usage now being designated metabolic-dysfunction-associated steatotic liver disease(⁵ 5 Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78:1966–86. ). If steatosis goes untreated, it progresses to inflammatory changes (metabolic dysfunction-associated steatohepatitis) in approximately 20% of patients, and approximately 20% of those patients evolve to fibrosis or even cirrhosis, which is an independent risk factor for hepatocellular carcinoma(⁶ 6 Huang DQ, Mathurin P, Cortez-Pinto H, et al. Global epidemiology of alcohol-associated cirrhosis and HCC: trends, projections and risk factors. Nat Rev Gastroenterol Hepatol. 2023;20:37–49. ). The growth in awareness of SLD has been accompanied by an improvement in its characterization through imaging, magnetic resonance imaging (MRI) having proved especially useful(⁷ 7 Pickhardt PJ, Graffy PM, Reeder SB, et al. Quantification of liver fat content with unenhanced MDCT: phantom and clinical correlation with MRI proton density fat fraction. AJR Am J Roentgenol. 2018;211:W151–W157. ). The development of confounder-corrected chemical shift-encoded MRI (CSE-MRI) techniques made it possible to obtain an accurate map of the liver fat percentage in a single breath-hold, being more precise in objective analysis than histology(⁸ 8 Bannas P, Kramer H, Hernando D, et al. Quantitative magnetic resonance imaging of hepatic steatosis: validation in ex vivo human livers. Hepatology. 2015;62:1444–55. ).

Introdução: a esteato-hepatite não alcoólica (EHNA) é uma das principais causas de doença hepática crônica, intimamente relacionada à obesidade e à síndrome metabólica, representando um risco significativo...